預算控制制度對醫院組織效能影響之探討－以角色壓力作為中介變數

The Influence of Budgeting Control System on Organizational Effectiveness: The Mediating Effect of Role Stress

10.6552/JOAR.2010.50.3

祝道松(Dauw-Song Zhu)；倪豐裕(Feng-Yu Ni)；盧正宗(Cheng-Tsung Lu)

預算強調 ； 專業承諾 ； 角色衝突 ； 角色模糊 ； Budgetary emphasis ； Professional commitment ； Role conflict ； Role ambiguity

會計評論

50期（2010 / 01 / 01）

57 - 87

繁體中文

在醫療專業科層的組織中，擁有權力與影響力的醫療專家們掌控了醫療作業程序，成為組織運作的核心。而醫療專家們從事管理活動主要是透過專業倫理所驅策的自我控制與同儕間的相互調整，因而醫療作業受到專業指揮系統的影響與主導，甚至跨越正式化的行政管理控制系統。因此，當組織強調正式化的行政控制機制時（如預算控制制度），在專業科層組織中擔任管理任務的專家可能會發生角色不相容（角色衝突、角色模糊）的壓力，而負向地影響組織效能。 本研究以國內區域級以上醫院為研究對象，透過角色壓力（角色衝突與角色模糊）來探討在不同程度的專業承諾情境下，預算控制制度對於提昇醫院組織效能所能扮演的角色。研究樣本包括10家醫院的303位預算部門主管。研究結果發現：(1)在高專業承諾導向的組織情境中，預算強調對組織效能並未存在直接因果關係，而是預算強調正向影響角色壓力，並透過角色壓力的中介影響效果，進而間接負向影響組織效能。(2)在低專業承諾的情境下，預算強調會對組織效能產生直接正向的影響效果；此外，預算強調亦會透過負向影響角色模糊，才間接影響組織效能。但是預算強調與組織效能間之關聯性，若透過角色模糊中介影響效果的解釋力，則會比直接影響效果的解釋力來的低。

In medical professional bureaucracy organizations, medical professionals are central to the organizational operation. Their behaviors are mainly affected by self-control and mutual coordination. Therefore, medical professionals often perceive role stress when organizations emphasize formal management control and thus it'll further negatively affect organizational effectiveness. To explore the relationship between budgetary control system and organizational effectiveness under different level of professional commitment orientation, this study applied path analysis to a sample of 303 budgetary managers in ten regional hospitals in Taiwan. Results supported the proposed hypotheses that under high professional commitment, the relationship between budgetary emphasis and organizational effectiveness can be fully mediated by role stress. However, under low professional commitment, the relationship between budgetary emphasis and organizational effectiveness can be accounted for by a partial mediation where budgetary emphasis decrease role ambiguity, and role ambiguity is negatively associated with organizational effectiveness. The explanation ability of indirect effect is higher than the direct effect.

1. 邱炳乾(2006)。預算目標達成對風險投資的影響：展望理論與過去績效歸因的探討。管理與系統，13(1)，77-97。
   連結：
2. 邱炳乾、林麗霞(2005)。預算參與前置因子、功能性認知與管理績效的結構關係探討：巢式分析。當代會計，6(1)，89-123。
   連結：
3. 張睿詒、李明純、張怡秋、陳楚杰(2003)。台灣地區醫院預算制度之質性研究：以六家區域級以上醫院為例。醫護科技學刊，5(2)，85-95。
   連結：
4. 陳耀東(2004)。全民健保不同支付制度對醫師執業行為之影響與比較。管理學報，21(2)，237-255。
   連結：
5. Abernethy, M. A.(1996).Physicians and resource management: The role of accounting and non-accounting controls.Financial Accounting & Management,12,141-156.
6. Abernethy, M. A.,J. U. Stoelwinder(1995).The role of professional control in the management of complex organizations.Accounting, Organizations and Society,20,1-17.
7. Abernethy, M. A.,J. U. Stoelwinder(1991).Budget use, task uncertainty, system goal orientation and subunit performance: A test of the fit hypothesis in not-for-profit hospitals.Accounting, Organizations and Society,16,105-120.
8. Aidemark, L. G.(2001).Managed health care perspectives: A study of management accounting reforms on managing financial difficulties in a health care organization.European Accounting Review,10,545-560.
9. Arany, N.,J. Pollock,J. Amernic(1981).An examination of professional commitment in public accounting.Accounting, Organizations. and Society,6,271-280.
10. Aranya, N.(1990).Budget instrumentality, participation and organizational effectiveness.Journal of Management Accounting Research,2,67-77.
11. Aranya, N.,K. R. Ferris(1984).A reexamination of accountants organizational-professional conflict.The Accounting Review,59,1-15.
12. Aryee, S.,T. Wyatt,M. K. Min(1991).Antecedents of organizational commitment and turnover intentions among professional accountants in different employment settings in Singapore.Journal of Social Psychology,131,545-556.
13. Blunenfeld, W. S.,T. R. Leidly(1969).Effectiveness of goal setting as a, management device: Research note.Psychological Reports,24,752-759.
14. Brownell, P.(1981).Participation in budgeting, locus of control and organizational effectiveness.The Accounting Review,56,844-860.
15. Bryan, J. F.,B. A. Locke(1967).Goal setting as a means of increasing motivation.Journal of Applied Psychology,51,274-277.
16. Chenhall, R. H.,P. Brownell(1988).The effect of participative budgeting on job satisfaction and performance: Role ambiguity as an intervening variable.Accounting, Organization and Society,13,225-233.
17. Chong, V. K.,K. M. Chong(2002).Budget goal commitment and informational effects of budget participation on performance: A structural equation modeling approach.Behavioral Research in Accounting,14,65-86.
18. Conrad, P.(1988).Learning to doctor: Reflections on recent accounts of the medical school years.Journal of Health and Social Behavior,29,323-332.
19. Creswell, J. W.(2002).Research Design: Qualitative, Quantitative and Mixed Methods Approach.Thousand Oaks, CA:Sage Publications Ltd..
20. Cuieford, J. P.(1965).Fundamental Statistic in Psychology and Education.New York, NY:McGraw-Hill.
21. Davila, T.,M. Wouters(2005).Managing budget emphasis through the explicit design of conditional budgetary slack.Accounting, Organization and Society,30,587-608.
22. Derber, C.,W. A. Schwartz(1991).New mandarins or new proletariat? Professional power at work.Research in the Sociology of Organizations,8,71-96.
23. Dillard, J. F.,J. T. Rigsby,C. Goodman(2004).The making and remaking of organization context: Duality and the institutionalization process.Accounting, Auditing & Accountability Journal,17,506-542.
24. Gerdin, J.(2005).The impact of departmental interdependencies and management accounting system use on subunit performance.European Accounting Review,14,297-328.
25. Govindarajan, V.(1986).Impact of participation in the budgetary process on managerial attitudes and performance: Universalistic and contingency perspectives.Decision Sciences,17,496-516.
26. Govindarajan, V.(1984).Appropriateness of accounting data in performance evaluations: An empirical examination of environmental uncertainty as an intervening variable.Accounting, Organizations and Society,9,125-135.
27. Govindarajan, V.,A. K. Gupta(1985).Linking control systems to business unit strategy: Impact on performance.Accounting, Organizations and Society,10,51-66.
28. Gregson, T. J. Wendell,J. Aono(1984).Role ambiguity role conflict, and perceived environmental uncertainty: Are the scales measuring separate constructs for accountants?.Behavioral Research in Accounting,6,144-159.
29. Hardy, M. E.,M. E. Conway(1978).Role Theory: Perspectives for Health Professionals.New York, NY:Appleton-Century-Corfts.
30. Hill, N. T.(2000).Adoption of costing systems in US hospitals: An event history analysis 1980-1990.Journal of Accounting & Public Policy,19,41-71.
31. Hirst, M. K.(1983).Reliance on accounting performance measures, task uncertainty, and dysfunctional behavior: Some extensions.Journal of Accounting Research,21,596-605.
32. Ittner, C. D.,D. F. Larcker(1998).Innovations in performance measurement: Trends and research implications.Journal of Management Accounting Research,10,205-238.
33. Jacobs, K.(1998).Costing health care: A study of the introduction of cost and budget reports into a GP association.Management Accounting Research,9,55-70.
34. Jacobs, P.,E. M. Hall(1994).Management control systems for hospital clinical services.CMA Magazine,68,19-22.
35. Kahn, R. P.,W. R. Quinn,S. Snoek,R. Rosenthal(1964).Organizational Stress: Studies in Role Conflict and Ambiguity.New York, NY:John Wiley & Sons.
36. Kaiser, H. F.,S. Rice.(1974).Little Jiffy mark IV.Educational and Psychological Measurement,34,111-117.
37. Kaplan, R. S.,D. P. Norton(1996).The Balanced Scorecard: Translating Strategy into Action.Boston, MA:Harvard Business School Press.
38. Kenis, I.(1979).Effects of budgetary goal characteristics on managerial attitudes and performance.The Accounting Review,54,707-721.
39. Kren, L.(1992).Budgetary participation and managerial performance: The impact of information and environmental volatility.The Accounting Review,67,511-526.
40. Leigh, J. H.,G. H. Lucas,R. W. Woodman(1988).Effects of perceived organizational factors on role stress-job attitude relationships.Journal of Management,14,41-58.
41. Lillis, A. M.(2002).Managing multiple dimensions of manufacturing performance-an exploratory study.Accounting, Organization and Society,27,497-529.
42. Liou, K. T.(1995).Understanding employee commitment in the public organization: A study of the Juvenile detention center.International Journal of Public Administration,18,1269-1295.
43. Macintosh, N. B.,J. S. Williams(1992).Managerial roles and budgeting behavior.Behavioral Research in Accounting,4,23-48.
44. Magner, N.,R. B. Welker,T. L. Campbell(1996).Testing a model of cognitive budgetary participation processes in a latent variable structural equations framework.Accounting, and Business Research,27,41-50.
45. Marcon, G.,F. Panozzo(1998).Reforming the reform: Changing roles for accounting and management in the Italian health care sector.European Accounting Review,7,185-208.
46. Marginson, D.,S. Ogden(2005).Coping with ambiguity through the budget: The positive effects of budgetary targets on managers' budgeting behaviors.Accounting, Organizations and Society,30,435-456.
47. Meehl, P. E.,N. G. Waller(2002).The path analysis controversy: A new statistical approach to strong appraisal of verisimilitude.Psychol Methods,7,283-300.
48. Miller, G. A.,L. W. Wager(1971).Adult socialization, organizational structure and role orientations.Adminstrative Science Quarterly,16,151-163.
49. Mintzberg, H.(1979).The Structuring of Organization: A Synthesis of the Research.Englewood Cliffs, NJ:Prince-Hall.
50. Mintzberg, H.(1983).Structures in Fives: Designing Effective Organizations.Englewood Cliffs, NJ:Prentice-Hall.
51. Neter, J.,W. Wasserman,M. H. Kutner(1990).Applied Linear Statistical Models.Homewood, IL:Richard D. Irwin, Inc..
52. Pennings, J. M.(1975).The relevance of the structural-contingency model for organizational effectiveness.Administrative Science Quarterly,20,393-410.
53. Rangone, A.(1997).Linking organizational effectiveness, key success factors and performance measures: An analytical framework.Management Accounting Research,8,207-219.
54. Rizzo, J. R.,R. J. House,S. I. Lirtzman(1970).Role conflict and ambiguity in complex organizations.Administrative Science Quarterly,15,150-163.
55. Sorensen, J. E.,T. L. Sorensen(1974).The conflict of professionals in bureaucratic organizations.Administrative Science Quarterly,19,98-106.
56. Steers, R. M.(1975).Problems in the measurement of organizational effectiveness.Administrative Science Quarterly,20,546-558.
57. Subramaniam, N.,L. Mia(2003).A note on work-related values, budget emphasis and managers' organizational commitment.Management Accounting Research,14,389-408.
58. Swieringa, R. J.,R. H. Moncur(1975).Some Effects of Participative Budgeting on Managerial Behavior.New York, NY:National Association of Accountants.
59. Thompson, J. D.(1967).Organization in Action.New York, NY:McGraw-Hill.
60. Van Sell, M.,A. P. Brief,R. S. Schuler(1981).Role conflict and role ambiguity: Integration of the literature and directions for future research.Human Rotation,34,43-71.
61. Williams, J. J.,N. B. Macintosh,J. C. Moore(1990).Budget-related behavior in public sector organizations: Some empirical evidence.Accounting, Organizations and Society,15,221-246.
62. 新制醫院評鑑基準
63. 倪豐裕、陳火坤、陳以亨(2001)。預算目標困難度、任務不確定性、預算強調對績效影響之研究：調節迴歸分析。商管科技季刊，2(1)，67-88。
64. 委員評核量表

1. 葉雅文(2017)。美容醫學競爭力指標建構之研究－以台南地區為例。長榮大學醫務管理學系(所)學位論文。2017。1-139。